Abnormal Uterine Bleeding in Adolescents
Menarche is an important event during adolescence. For most girls, it marks completion of puberty and the onset of reproductive capability. Menarche usually occurs when both breast and pubic hair development are at Tanner stage 4. Menstrual problems are common during adolescence due to slow maturation of the hypothalamic-pituitary-ovarian axis and can last 2 to 5 years after menarche. Although most problems are explained by anovulation, other causes must be considered and excluded in a logical and cost-effective manner. Frequently, the bleeding problems observed in adolescence require evaluation and intervention.
Menstrual irregularities are a common gynecologic problem, especially in adolescents. Abnormal uterine bleeding (AUB) is any form of bleeding that is irregular in amount, duration, or frequency. It can be characterized by excessive uterine bleeding that occurs regularly (menorrhagia), by heavy bleeding at irregular times (metrorrhagia), or a combination of both (menometrorrhagia). It can also be intermittent bleeding or sparse cyclical bleeding (oligomenorrhea). Dysfunctional uterine bleeding (DUB) is a subset of AUB and is defined as excessive, prolonged, or unpatterned bleeding from the endometrium without an organic cause and is frequently used synonymously with anovulatory bleeding. In adolescents, up to 95% of AUB is DUB. However, because DUB is a diagnosis of exclusion, other potential causes of abnormal bleeding must be ruled out. This article discusses the physiology, evaluation, diagnostic testing, and treatment of anovulatory bleeding in the adolescent.
Abstract
Menarche is an important event during adolescence. For most girls, it marks completion of puberty and the onset of reproductive capability. Menarche usually occurs when both breast and pubic hair development are at Tanner stage 4. Menstrual problems are common during adolescence due to slow maturation of the hypothalamic-pituitary-ovarian axis and can last 2 to 5 years after menarche. Although most problems are explained by anovulation, other causes must be considered and excluded in a logical and cost-effective manner. Frequently, the bleeding problems observed in adolescence require evaluation and intervention.
Introduction
Menstrual irregularities are a common gynecologic problem, especially in adolescents. Abnormal uterine bleeding (AUB) is any form of bleeding that is irregular in amount, duration, or frequency. It can be characterized by excessive uterine bleeding that occurs regularly (menorrhagia), by heavy bleeding at irregular times (metrorrhagia), or a combination of both (menometrorrhagia). It can also be intermittent bleeding or sparse cyclical bleeding (oligomenorrhea). Dysfunctional uterine bleeding (DUB) is a subset of AUB and is defined as excessive, prolonged, or unpatterned bleeding from the endometrium without an organic cause and is frequently used synonymously with anovulatory bleeding. In adolescents, up to 95% of AUB is DUB. However, because DUB is a diagnosis of exclusion, other potential causes of abnormal bleeding must be ruled out. This article discusses the physiology, evaluation, diagnostic testing, and treatment of anovulatory bleeding in the adolescent.
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